Internal Medicine

Although it has been quite a while since I've posted, and it seems like forever since my Internal Medicine rotation, I'm still going to try to fill in the blanks over the past year.  I guess when I'm this far removed from the experience, I'll only remember the important stuff anyway.

Internal Medicine was a 3 month rotation, the longest of the year.  My first month was my Parkland ward month, which is notorious for being the toughest.  By the way, I learned recently that I've used the word notorious incorrectly in the past, using just as "well known," but Mark informed me recently that it is basically the same as "infamous."  So, I'm using it now in it's correct context :)  Internal Medicine is basically just adult medicine, and it covers a really wide range so it was a densely packed learning experience.  People often ask me when I tell them I'm going into Pediatrics if I have a hard time seeing sick and suffering kids.  Obviously, yes that can be difficult, but I had a harder time on Internal Medicine seeing a lot of people with disease processes that there wasn't much to be done about.  During my Parkland month, we had a lot of chronic liver disease and cancer, two diseases that can have a pretty mean course.  I was thankful for the opportunity to work with and learn from these patients, but I figured out pretty quickly that Internal Medicine was not going to be the path I would take.

My second month was at Baylor in Dallas, my first private hospital experience.  It was a different world I stepped into, a world of insurance and discussions about what a patient could pay for based on their coverage, something I was not used to.  On one hand, it was nice to know that many patients had good places to go when they left the hospital, and we didn't have to battle the "which transitional care/nursing facility will take this person who doesn't have funding" dilemma.  On the other hand, there were a few times I saw, what I thought was, medicine practiced for financial gain.  Meaning, patients staying in the hospital longer than necessary, or tests ordered that I had learned did not give much valuable information.  It was a strange, unpleasant feeling to talk about how a patient needed to be transferred to Parkland because they weren't funded, or that they wouldn't be able to receive life-saving dialysis because they were Medicaid and they would need to get in line at Parkland for their treatments.  It was not a setting I particularly enjoyed, and even though there are times I get frustrated with the crowded rooms or long wait times at Parkland, it made me thankful to learn medicine in a county hospital.

My last month was outpatient clinics which was really enjoyable.  I am pretty sure I want to practice outpatient rather than inpatient medicine, or at least a combination of the two.  I spent time in clinics specializing in Infectious Disease, Nephrology, Endocrinology, Cardiology, Gastroenterology, and general Medicine.  Almost all of it was at the VA Hospital, which I grew to love.  It was a great learning experience and pretty laid back, so a fun way to end a marathon of a rotation.  After I finished the exam at the end of this block, I realized just how much I learned and how great a foundation those 3 months helped to build.